Memorial 100 Sporting Clays Donation

Donor Information (please print or type)

Name

 

Billing address

 

City

 

State

 

ZIP Code

 

Telephone (home)

 

Telephone (business)

 

Fax

 

E-Mail

 


Donation Information

I (we) plan to donate cash and/or product with a total value of $ ____________

Qty

Item

Value

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

                  
I (we) plan to sponsor an Event or Field in the amount of $ _______________
 
Payment:         _____cash/check  ____credit card _____other

Credit card type

 

Credit card number

 

Expiration date

 

Authorized signature

 


Acknowledgement Information

Please use the following name(s) in all acknowledgements:

 

Thank you for your support.  Please make checks, corporate matches,
or other gifts payable to:

Timothy L Correll Foundation, Inc
209 First Street West
Jordan, Minnesota 55352

The TLC Foundation is a 501(c)3 non-profit organization. 
Contributions are tax deductible as allowed by law.